Healthcare Provider Details

I. General information

NPI: 1649184995
Provider Name (Legal Business Name): CESAR ALAN LOPEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 TAYBRIDGE LN
DOTHAN AL
36305-6925
US

IV. Provider business mailing address

109 TAYBRIDGE LN
DOTHAN AL
36305-6925
US

V. Phone/Fax

Practice location:
  • Phone: 706-566-0858
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: